Suzette Dimascio - Specialty Pharmacy Podcast

In July 2018, the Centers for Medicare and Medicaid Services (CMS) proposed new rules regarding the implementation of the Medicare Part B Improvement Act and section 5012 of the 21st Century Cures Act which directly affect the home infusion industry. The new rules and requirements have raised serious concerns among industry stakeholders, that if not addressed, stand to adversely compromise the marketplace as a whole.

In this special episode, Kendall Van Pool, vice president of government affairs at the National Home Infusion Association (NHIA), joins host CSI Specialty Group President and CEO Suzette DiMascio, CHE, CMCE, CPC, to discuss the latest developments and challenges in the home infusion marketplace. He also shares how listeners can make a positive impact on the future of home infusion with a key hearing taking place this week.

“If this doesn’t go through the way we need it to, affordability will come into play again and potentially affect patient treatment patterns,” says DiMascio. “If you’re a patient, we definitely want to hear your perspective.”

Tune in to Discover:

  • A historical review of the Catastrophic Coverage Act, the Medicare Modernization Act and how home infusion coverage became a fractured benefit under the Medicare program
  • Congress’s (precarious) efforts in the past two years to get us where we are today
  • How the CMS interpretation of the new 21st Century Cures Act legislation misses congressional intent and poses significant threats to patient care, delivery, and reimbursement
  • What you can do to voice your opinion, influence the CMS, and help rectify the situation

Let Your Voice Be Heard

CMS needs to hear from you on this matter. It is important that CMS hear from a wide spectrum of stakeholders to gain a broad perspective and understanding of the serious implications to beneficiaries. Volume is key and personalization is most effective. The deadline to submit comments is August 31, 2018.

NHIA has developed a letter to assist you in providing your own organization’s comments to CMS. The letter and other resources are available on the NHIA advocacy webpage by clicking here. Urge CMS to modify the proposed rule and provide your comments today.

About Kendall Van Pool

Kendall Van Pool is the Vice President of Government Affairs at the National Home Infusion Association, a trade association that represents and advances the interests of organizations that provide infusion and specialty pharmacy products and services to the entire spectrum of home-based patients.

Kendall has been instrumental in developing and promoting the legislative and regulatory policy agenda of NHIA.  In doing so, he directs wide-spectrum of advocacy activities that are focused on clinical and business best-practices that may be subject to legislation, regulation, accreditation, practices of health plans/third party payers, and more.  

Kendall is a Washington DC veteran with 18 years of experience working on Capitol Hill and in various health care advocacy positions.

About CSI Specialty Group

CSI Specialty Group is a globally recognized leadership, strategy and talent consulting firm dedicated to helping clients drive sustainable, accelerated growth while continually elevating the specialty pharmacy industry. By providing inventive specialty pharmacy consulting, workforce planning and talent acquisition solutions, CSI uniquely tailors its service offerings to help clients drive sustainable, accelerated growth. As the provider of the industry’s first, dedicated podcast for specialty pharmacy, CSI is at the forefront of pioneering innovative concepts to meet the changing needs of specialty pharmacy, home infusion, mail order/PBM, health systems and pharma/biotech clients across the USA and throughout Europe.

Transcript Notes:

Welcome to the Specialty Pharmacy Podcast, your prescription for specialty pharmacy success. Now, here’s your host, globally recognized industry leader and CEO of CSI Specialty Group, Suzette DiMascio.

Suzette D.:           Hi, good morning. This is Suzette DiMascio with the Specialty Pharmacy Podcast from CSI Specialty Group, and today, we have a little different format for you. It’s actually going to be an educational forum on home infusion in the Medicare program as well as a call to action. So this is a really important podcast for our listeners to pay close attention to.

Joining me today will be Kendall Van Pool, who is the vice president of legislative affairs at the National Home Infusion Association, which as we all know is a great trade association that represents and advances the interest of organizations that provide home infusion and specialty pharmacy products in the home for patients that are home bound or need their care in home, I should say. Kendall, you’ve been so instrumental in developing and promoting a lot of the policy agenda for NHA. I’m so excited that you could be part of us today. You’ve been part of the working infrastructure on Capitol Hill for many, many years and would love for you to talk a little bit about what’s happening in the marketplace today and how our listeners can help with actually one of the hearings that will be taking place later this week.

Kendall V.:           Well, thank you so much for your time today, and I am pleased to be here, Suzette. It’s a wonderful opportunity to get out the word on everything that we’re working here at NHIA, specifically around this proposed rule that CMS has put out and our concerns with it. So if we want to dive right in, I’ll turn it over to you to get going, but I do want to thank CSI and everyone for all the hard work and the support that you give NHIA. We need our members and others to take action now, and this is a great opportunity to be working towards that.

So go ahead if you want to get started, and you can set the stage a little bit here and maybe I can discuss how we got to where we are.

Suzette D.:           Sure. Sure. Fantastic, and again, thanks for joining us. Home infusion, as I take a look at it, my roots come back to home infusion back in my first healthcare days working for NMC Homecare back in the day, and it’s been a very fractured benefit under Medicare, with the pockets of reimbursement in Part B of the program and other drugs covered in Part D of the Medicare program, and over the past two years, it seems that Congress has been very active in their efforts to shore up the broken coverage paradigm. Maybe you can set the stage for us, Kendall, on Congress’ efforts in the past two years, by giving us a retrospective review of how we got where we are today.

Kendall V.:           Sure, no problem at all. I guess the best way to start this out is to get back in our way back machine and go to somewhere around 1987. Right around 1987, a process on Capitol Hill started to move forward with regard to a piece of legislation called the Catastrophic Coverage Act, and home infusion was a budding industry at the time, very much so focused on antibiotics. The Catastrophic Coverage Act included a provision in it that created a home infusion benefit for antibiotics. That legislation moved forward and it was passed and it was in law for about 19 months.

Interestingly enough, nothing to do with the home infusion issues, it was a much larger piece of legislation, and the way that the bill was funded, I think we’ve all learned our lessons not to do this now, but they really based the funding of the legislation off of higher copays and higher premiums for seniors. Clearly, that did not sit well with the seniors in the Medicare program at the time or individuals that were getting close to Medicare age, so there was a big revolt against this piece of legislation, and eventually, it was repealed.

So after the Catastrophic Coverage Act was passed, much of the framework of what a home infusion benefit would look like in legislation was laid. So for decades now, we have been using that piece of legislation as somewhat of a framework to move forward on legislation for home infusion coverage. Now, when that bill did not move forward, or actually, I should say, when that bill was repealed, we were left with really no coverage for home infusion. It was primarily a space of antibiotics at the time, but other therapies were coming online. What happened was Congress and CMS and others started looking for ways to, I don’t want to say shoehorn or back door home infusion coverage into the program, but at least try to get some therapies covered in the Medicare program.

Let me remind you, this is before the Part D Medicare modernization act, which we’ll talk about a little bit later. So what they were working towards was some sort of coverage in the Part B program, and the best way to work towards that policy was a reimbursement for the drugs as a supply to make a mechanical infusion pump work. It’s a little bit backwards, but what they did was they basically said that a pump was actually the covered item. It’s a covered DME item, it’s durable, and so that definition led to, okay, well, a drug could make the pump work. So they started outlining what drugs they could fit into that space.

Suzette D.:           Interesting. Interesting. And what therapies were included in that DME program?

Kendall V.:           Well, the list has been growing over time. What we’ve seen is there’s been opportunities with various drugs to enter into the program. Let me remind you that the DME is actually the covered item, and it’s a piece of durable medical equipment. So elastomeric devices, some of the other devices used by home infusion providers to deliver the medication, aren’t what they consider durable. So the way that [inaudible 00:06:56] worked was the drug had to require an infusion pump to be delivered.

Now, it’s changed a little bit over time, but right now, it’s 39 total drugs that are in this space. Examples of these drugs include inotropic drugs, subcutaneous immune globulin therapies. I should note that IVIg is not in the DME benefit. It is part of the program in Part B, but it’s not one of the 39 drugs. And then there’s some chemo drugs and some other drugs. I’d say really, if you’re talking about utilization, what drugs are in here that are utilized, it’s really two therapies that fit there. It’s [inaudible 00:07:45] and subcutaneous immune globulin therapies.

Up until 2003, when the Medicare modernization passed, this was really the paradigm structure, but then things changed with the 2003 Medicare Modernization Act.

Suzette D.:           Gotcha. Gotcha. That’s interesting, because I know with a lot of the new molecules coming out with subcu IG that the manufacturers are paying close attention to this, as well.

So as the modernization act started to change things and healthcare and looking back into the 2000s, the Medicare program and healthcare in general went through a lot of change. As you take a look at home infusion, how did it fit into this change? How did Med D come into play? What did it do in the industry?

Kendall V.:           Well, as I noted, it’s only about 39 drugs in that Part B space, and really just a couple antibiotics are in there. I shouldn’t say antibiotics, I should say they’re primarily antifungals that are in that space in the Part B DME program.

What Part D did, and the Medicare Modernization Act, it became the coverage component for all the other drugs that weren’t in the Part B benefit. What does this mean? The antibiotics, anything that’s not associated with an infusion pump ends up in that program. So interestingly, what it really did is it created a new fractured component of coverage for home infusion, and it’s only the drug. So for Part D as in dog drugs, they are really only the drug is covered. None of the professional services associated with them, the pump is not covered, the supplies are not covered, but there is this component of Part D coverage there.

The other thing that happened in that Medicare Modernization Act was they did one thing with those drugs in Part B. If you follow drug reimbursement in the Medicare program, there’s been a lot of talk around ASP pricing, AWP pricing. Before the Medicare Modernization Act, the drugs were at AWP minus 5% or 95% of AWP. That’s average wholesale price. They moved all of the drugs in the Part B program, meaning physician office, hospital outpatient, to a new pricing mechanism back in 2003. Now it’s average sales price. So they moved it to ASP plus 6%. Weirdly enough, for home infusion, they recognized then that the drug reimbursement was capturing some of the professional services associated with home infusion, and so they froze the rates at AWP 95% of 2003. And when I say froze, they did not update those reimbursements, so over time, it was 2003, the further you get away from 2003, the further you get away from the market dynamic.

But we’ll talk about that in a second. I would say not a lot happened through the rest of the 2000s for home infusion, except for the fact that the industry knew that the further we got away from 2003 and these rates, the more they would be less reflective of a true market reimbursement for those drugs. The other thing is, this was the entree into a real conversation around real Medicare coverage for home infusion, because they said they knew that those services needed to be reimbursed.

And so the industry prepared for that, and we prepared for it and when the opportunity arose, which was the ACA and the Affordable Care Act or Obamacare came about, that really was our opportunity to be working towards some sort of home infusion coverage.

Suzette D.:           Mm-hmm (affirmative). And so as we take a look at the Affordable Care Act and it was mostly geared towards private sector coverage where anyone could potentially pick out whatever health plan they felt was best for them, there were some Medicare provisions in the legislation. Was this the opportunity to get home infusion coverage back into the Medicare … Excuse me. Was this the opportunity for home infusion coverage in the Medicare program to be fixed?

Kendall V.:           Yes, it was the opportunity, and I should say it was not the only opportunity, but it was the real opportunity where people were talking [inaudible 00:12:49] in a concerted way, and so we had been working on a piece of legislation that was originally introduced three years prior, in 2006, and that was a piece of legislation called the Medicare Home Infusion Coverage Act. Eventually, if people have been following this issue, they’ve heard the Medicare Home Infusion Site of Care Act. Originally, it was called the Coverage Act. We changed the title of the legislation only to really reflect that the infusion is covered in the Medicare program, just not in the home, so that’s where the Site of Care Act came about later on.

But at this point, it was the Coverage Act, and the paradigm of that piece of legislation was a reimbursement very much so akin to how the private sector does it. So a per diem coverage. It would be based on the S code set, which we had into effect at that time period, and it would have nursing separately billed. That’s an important point that I’ll get to in just a second. Then the drug reimbursement would, there were different iterations of this legislation, but most of the time, what we were trying to do was not upset the apple cart with regard to the drug reimbursement in Part D and Part B. We had conversations about could we move the drugs that are in B into Part D or the drugs in D into Part B, and that became an ongoing conversation.

But what happened was, we took this piece of legislation forward and the finance committee during the ACA, what they call a markup on Capitol Hill. That’s where a committee reviews a piece of legislation. The term markup comes from if they’re going to amend it, they’re going to mark it up-

Suzette D.:           Mark it up.

Kendall V.:           … with a pen.

Suzette D.:           Makes sense. And they probably make it look like someone’s murdered on that page by the time they’re done.

Kendall V.:           [crosstalk 00:14:51]. Exactly. Exactly. Well, and so what they did during that time period, they brought forth this piece of legislation and they sent it also to the Congressional Budget Office. They didn’t get an official what they call score from the Congressional Budget Office, but what the Congressional Budget Office does is they review legislation for its effects on the federal coffers. So it’s not a conversation about the policy. The policy is the policy. It’s up to Congress to decide if it’s good policy or bad policy. But what they say is, “This is going to increase the cost of the Medicare program or save money for the Medicare program.”

Unfortunately, what they said for the structure of the legislation was there’s no policy governor at the time on reimbursement for that nursing, and so what was in the legislation was basically you could get reimbursed for nursing for the duration of every single infusion. Well, we know that in the private sector, that’s not how it works and you just don’t even have enough nurses to send out for the duration of every single infusion, so it’s a bit of what I like to call a policy ghost or one of these things that you talk in the policy world as a possible future reality, but it’s just in the real world not really what happens.

But the problem was, they said that this piece of legislation, because of that, would be highly expensive for the federal government, to the tune of I think it was $20 billion dollars.

Suzette D.:           Wow.

Kendall V.:           Which we know home infusion is going to save money for the federal government.

Suzette D.:           Correct.

Kendall V.:           But that’s what happened, and it kind of killed the bill at that point.

Suzette D.:           Hmm. So let’s kind of piggyback, I want to make sure that we have enough time during our conversation to discuss the 21st Century Cures Act and the call to action that we need our listeners to help us with this week. There’s just so many things that have been happening, as you spoke about, since 2003 and ACA as well as some of the things that started happening in 2013.

So when you take a look at, in your opinion, at what point does the Part D drug reimbursement structure become outdated and actually catch the eye of CMS?

Kendall V.:           Yeah, I mean, it really does … You hit a problem here, you’re exactly right. Starting around 2013, the OIG, the Office of the Inspector General, started looking at this AWP 95% reimbursement, and they noted it’s really about 66% of the drugs would be considered over-reimbursed, versus the ASP pricing that the physicians and the hospital outpatient departments were getting, and really about 33% were under-reimbursed. So it’s not that they were all over-reimbursed. There was a split here, but at that point, people started looking at it and saying, “Wow, we could save a bunch of money if we moved these drugs to ASP pricing. Why don’t we do that?” And so that’s where the 21st Century Cures Act comes in and where things really started to shift for home infusion.

Suzette D.:           Okay, so that makes sense. As things started to shift, so let’s talk a little bit about, for our listeners, how you see 21st Century Cures Act today and what needs to be happening from a congressional perspective.

Kendall V.:           Got it. Well, so 21st Century Cures Act came forward and it included a provision, the original bill was in 2015, that moved the drugs from average wholesale price to average sales price, and it was scored as a savings by the Congressional Budget Office that we talked about before, as a savings of about $660 million dollars, and that really started to drive the train on policy around home infusion was this drug reimbursement shift, because at the time, it didn’t include any reimbursement for the services. Which if we dial back to 2003, was the exact reason why everything was kept at AWP pricing.

So it all came down really to the Wednesday before the Cures Act was released to the public, and then passed in December, that there was an uphill climb there to really get these services reimbursed, and that’s where we go back to this Home Infusion Coverage Act and the things that needed to be changed. We worked to alter the structure on the nursing so we wouldn’t get this horrible score going along with it, and it really became truncated to just providing a services reimbursement or the services associated with the Part B, DME infusion drugs. So before, we were talking about the Part D drugs and everything. This, because they were changing reimbursement on the Part B drugs, they were looking to do a slimmer version of all of it for the Part B drugs rather than kind of the larger structure.

So you would think that we got all that in, we were ready to go, but unfortunately, the ASP pricing in the legislation took effect in 2017 and the services reimbursement took effect on January 1, 2021.

Suzette D.:           Which I thought was absolutely insane. How in God’s name could they have done something like that? Oh, I forget. It’s Congress. It made no sense to me.

Kendall V.:           Yeah, that’s a big one. So it’s a big problem, having that four-year gap, and immediately … This was, the Friday after Thanksgiving we got the legislation and immediately, we started crying foul and saying, “Hey, guys. This is a problem,” and we really started to work with the chairman of the Ways and Means Committee and the Energy and Commerce Committee to discuss the issue. They eventually did, as they were moving the 21st Century Cures bill forward, to fix the issue, but they couldn’t do it because the text of the legislation was out there, it was really set in stone, so they made the promise to fix the issue.

Suzette D.:           Mm-hmm (affirmative). Interesting. And so this is kind of the promise that hasn’t been made yet, hasn’t been taken care of yet.

Kendall V.:           Yeah. It hasn’t been taken care of yet, and so you would think that they could just move the effective dates around and everything would be good. The reality is, they can’t. The policy structure, so there’s a couple hurdles to that policy structure, and that was CMS needed to set the rates for the services reimbursement and it takes time for them to do that. So what we really need them to work for, for this interim time period, was a policy that would create what we call a temporary reimbursement for home infusion for 2019 and 2020.

Suzette D.:           I remember that. So the whole new bill just for two years of reimbursement, correct?

Kendall V.:           Well, I would say kind of. But what they did, and this became the transitional reimbursement that we talk about, and our temporary transitional reimbursement. There’s different versions of what we call it, but it was passed in the bipartisan budget act, and it really builds off the 21st Century Cures provisions, but it does … and actually, I should say this also, specifically a lot of the definitions of certain terms carry through, specifically the term home infusion, professional services, including nursing, we can talk about that in a second, and the calendar day of administration. So those [inaudible 00:23:36] carry through, but there were other provisions in there that were on its own, like setting the reimbursement, setting which drugs will be covered. A lot of those things are very specific to the Balanced Budget Act.

Suzette D.:           So just to kind of bring everything to the forefront, this has been a wonderful overview of where things are in the past and where we need to bring it in the future. So what’s happening this week? I know that NHIA has some concerns with the CMS proposed rule to implement this legislation, so tell me, what are the concerns and what can we have our listeners do as a call to action to voice their opinion, especially listeners that will be affected by this?

Kendall V.:           For sure. So the proposed rule is out. It’s been out since July 2nd, and we just gave a lot of history around this, but it all comes together in the proposed rule. So what a proposed rule is, just for the listeners, a proposed rule is the way that the administration will signal how they want to implement a piece of legislation. It embodies itself in what is a final rule that will be put forward a little later this year. But a proposed rule is the opportunity for them to signal to the public, “This is what we plan on doing. This is what we’re proposing,” and then open up a comment period for the public to respond.

So the call to action that we’ll get to in two seconds is we need anyone and everyone to comment on the proposed rule, because we think that CMS has really taken a turn in a bad way in implementing this legislation. We don’t think that they’ve gotten to congressional intent. And so what is in this proposed rule that we’re commenting on? There are two big items in this proposed rule that are highly important. What these said is what we call a physical presence requirement, and what-

Suzette D.:           I read that.

Kendall V.:           … is that a nurse needs to be in the home for the duration of … or not the duration of every infusion, but on the day of an infusion, for the rate to be billable. It’s always been our understanding that the Hill, Congress, really meant to have every day that an infusion is happening, regardless of someone being in the home, billable. In short, what that really means … Let’s take a drug like milrinone. Milrinone is an inotropic drug that is delivered daily, 24 hours a day for that patient, and infusion happens every single day. What they basically said is that really only one day a week is billable, and that’s when the nurse is physically present in the home. [crosstalk 00:27:02].

Suzette D.:           And that’s counterintuitive to empowering the patient, too.

Kendall V.:           What?

Suzette D.:           I was going to say, that’s counterintuitive to empowering the patient, as well, because you want the patient and the caregivers to understand how to take care of themselves, as well, and it wouldn’t end up costing more money-

Kendall V.:           You got it.

Suzette D.:           … to the health plan.

Kendall V.:           You would think. You would think, but interestingly enough, if you go to the economic section of the bill, they state that they would only think that a nurse would be in the home once a week. So again, the milrinone again, $141 per day of reimbursement. If they … What we always thought was that would be every single day of infusion. So seven days, $141 each day. What they basically said is, “No, no, no. Only when the nurse is there would it be reimbursed,” and it would really equate to, I’ve actually done the math on this, $20.16 a day in reimbursement, which is, I would say, laughably low.

So as we look forward, there’s that piece of it. But secondarily, they haven’t defined professional services, including nursing, appropriately in the rule, and what they said is really it’s only nursing. So that’s how they get to this physical presence requirement. So they basically said nursing is really the only service, so when is a billable day? Well, it’s when the nurse is there. They haven’t included pharmacy, they haven’t included case management, all of the other things that go on really when someone isn’t in the home but are highly skilled services. Compounding the drug, it needs to be covered, and that’s what a big portion of this is all about.

So second, I mentioned there are two things in this rule that are a big problem. The second is, they need to be defining professional services specifically for home infusion and including pharmacy and case management along with the nursing. I don’t want to minimize the nursing, it’s a big part of what we do, but it’s not all that we do. So when it comes to this rule, our big problem right now are these two issues, and that’s where, as you noted, taking action comes in.

NHIA has provided an opportunity for go on to our website, it’s just, and click on the advocacy tab at the top and it’ll take you to our advocacy website. There you can click on the take action tab and when you click on that take action tab, it takes you to a link where you can comment on the rule, and we’ve provided comments that you can use. I would highly recommend that the listeners edit it and talk about how this would affect them, how it would affect their patients, how it would affect all involved in home infusion and how they’ve really taken this physical presence requirement and ran with it inappropriately in the rule, and they need to fix that.

So that’s where we need this action to be taken, and I hope that the listeners will heed this call to action. It’s vitally important that we get comments in on this rule.

Suzette D.:           So once the comment period is closed, when typically do you see their reply to the rebuttals? When would you anticipate? Would it be this year? Would it be next … in the beginning of the year? What typically happens?

Kendall V.:           There’s a law called the Administrative Procedures Act that outlines all of this, so it’s fairly structured, which is nice, because you can kind of count on it. The way it would work is this proposed rule and comment period ends of the 31st of August, and then there’s a little bit of downtime when it comes to CMS processing all of the comments. Hopefully, there’s a lot of them to process. And then basically it requires 60 days before the effective date of the rule. Because the transitional reimbursement’s effective date is January 1st, you just have to dial that back 60 days, which I’m trying to remember if it lands itself on November 1st or 2nd, but it’s one of those two days. We’ll see the final rule around November 1st or 2nd that’ll put this all into place, and we really hope that they do not move forward with that they’ve got right now, and that would be a big problem.

Suzette D.:           So we’re wanting a really good Thanksgiving for not just the history in specialty pharmacy industry, but more importantly, for the patients.

Kendall V.:           You got it. If we get this in place and we get them though change their mind on these issues, it’s going to be a great time period to start getting ready to service these patients starting January 1st with this services reimbursement in place. We started this call talking about 1987 and the fact that there was a piece of legislation that moved forward. We’re now almost three decades later, and we are at the precipice of getting this right if we can get CMS to get it right, which would be a huge step in the right direction for the Medicare program and for patients.

You’re absolutely correct that it would be such a great thing over Thanksgiving and into the Christmas time period to be working on a good benefit for the beneficiaries we serve. I think that sometimes we talk about these reimbursement issues and we don’t get down to the root of all of it, and it’s as home infusion providers, we want to be servicing these patients in their home, giving them good quality of life and the opportunity to not have to go into a healthcare environment for these services that can be done at the home. It’s just a win for everyone.

Suzette D.:           I agree. I agree. Well, I appreciate you taking both a retrospective look and hopefully a prospective look on what we want the future to look like in order for patients to have the right coverage and be able to afford their therapies. That’s another big thing is if this doesn’t go through the way we need it to, affordability is going to come back into play again and potentially affect their treatment patterns.

Just for our listeners, we will have a link on our website where you can contact Kendall as well as going to the National Home Infusion Association’s website to be able to see some example letters that you can tailor to your particular company, industry, and if you’re a patient, we definitely want to hear a patient’s perspective, don’t we Kendall?

Kendall V.:           Yes, we do. It’s highly important to not just get the voice of the industry, but get the beneficiaries that CMS serves. CMS is not in the business of serving home infusion providers. They are in the business of serving beneficiaries, so hearing from the beneficiaries is highly important.

Suzette D.:           Perfect. Perfect. Well, I just so appreciate your time today. So now our listeners, it’s up to you. Take the time, go to NHIA’s site, take a look at what’s happening and help us help patients around the country get the coverage that they need for the therapies that they so desperately need.

Kendall, what I would love to do is get you back on in November and toast to the success of this.

Kendall V.:           I would love that.

Suzette D.:           Thank you. Thank you so much.

Speaker 4:            Have you heard the news? The 2018 State of Specialty Pharmacy report is now available to download for free at For the report, we surveyed specialty pharmacy professionals of all level across all the main channels to uncover trends, opinions, and future predictions about the specialty pharmacy industry. Please feel free to download the report today and find out what manufacturers, health systems, and independent specialty pharmacy professionals across the nation say the biggest opportunities as well as the biggest challenges are, as we all work toward improving the patient journey. Get your free download today at

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About The Specialty Pharmacy Podcast

Join host Suzette DiMascio, CHE, CMCE, CPC, President and CEO of CSI Specialty Group, as she answers questions, addresses concerns and discusses the news you need to stay on top of the ever evolving world of specialty pharmacy. Tune in every episode to hear real world examples of the good, the bad and the outrageous from the experts at CSI Specialty Group, and to learn about the limitless growth opportunities available in the specialty pharmacy industry.